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2Digital, Health Communication and Public Relations Theory and Practice.

How can digital PR help to create effective cancer communication with reference to the Ulster Cancer Foundation

This paper is supported by 15 appendices

1. IntroductionThe Ulster Cancer Foundation (UCF) is a Northern Ireland charity dedicated to helping patients

and their families cope with cancer. It was established in 1970, becoming the first local cancer charity. Its mission has remained focussed, to save lives & provide an enhanced quality of life for

all those affected by cancer through care services, researching new & better treatments for cancer, cancer education & prevention programmes, public campaigns & advocacy. The charitys

roots are closely associated with the birth of public relations in Northern Ireland, being founded as a result of the fundraising efforts of Gordon Duffield, one of the first PR consultant practitioners in

Ulster (Duffield, 2003). It is perhaps fitting that 40 years on this short paper looks to the future, analysing digital media, health communication and public relations theory and how the Ulster

Cancer Foundation can adapt to the opportunities emerging from digital public relations. All these theoretical and applied areas are high on the PR agenda with LEtangs (2008, p136-157)

call for research in health and sector PR, extensive cancer PR studies from the National Cancer Institute (1998-2009), Seth Noars 10 year review of health communication campaigns (2006),

digital health PR studies from Abroms et al (2008) and increased interest in Digital PR and PR models (Broom,2009: LEtang,2008: Davis, 2007; Theaker, 2008, Grunig & Hunt, 2002, Flynn

2006, Dozier et al,1995, CIPR Series and web guides, 2009: see appendix 1 for researchers comment ). Content analysis of the Ulster Cancer Foundation (UCF) web site helped to assess

the current situation of digital PR in the organisation, provide the beginnings of a gap analysis, and steps needed to prepare the UCF for positive engagement with this new media.

2.0. Digital Media and PR Health Campaigning. Situation and IntegrationAbroms et al (2008) note the excitement about new media among public health communication and PR professionals (p3). They conclude that by 2008 few public health campaigns had used

new media and few have been published this is despite the fact that 95 million adults search online for health information and there is an increasing use of digital media in Northern Ireland

(Pew Internet & American Life Report, 2005; The OFCOM Communications Market Report, August 6th 2009, appendix 2).

Initial findings from research show that digital PR is also having a positive impact. Abroms et al

(2008) study concludes that the integration of new and traditional media is working, with excellent dissemination of messages and opportunities to prolong the message (especially

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3with You Tube and web site downloads). While it took time to generate traditional materials they noted the cost effectiveness of transfer of content to new media.

Research by Salmon and Atkin (2003) stresses the importance of the right channels to get the

message out with multiple tactics to ensure reach and repetition (McGuire, cited in LEtang, 2008; NCI, 2009). However the kitchen sink approach with as many as 12 components is not

recommended (Miller et al, 2000).

The result is, that UK cancer charities are beginning to use the integrated mix with traditional media, blogs and broadcasting (MacMillan Cancer, CRUK, 2009, Magee, PR Week, July &

August: appendix 3). In a small way the UCF have attempted to engage with its publics in a digital manor. For the 2009 prostate cancer campaign, UCF created and issued an information DVD,

providing key facts and information on self checking, signs and symptoms as well as ways to help reduce a persons chance of developing prostate cancer. Despite the key information included,

access to the DVD was only via one channel. As stated later in this work, by embracing a more digital website such information could be available at the click of a button.

2.1. Digital PR and Health Campaigning. The Levels, Models and StylesThe advantage of User Generated Communication is that it can play an active role in the 5 levels of cancer communications: individual, group, organisation, community and society level (NCI,

2009). It can also contribute to the many health communication models, whether public information campaigns (one way communication, sender to receiver) or public communication

campaigns (two way communication, encouraging dialogue). Because of the power of information delivery and potential dialogue in digital media it is an ideal vehicle to implement Tones and

Tilfords 1994 health models. The first is the preventative model or what LEtang (2008) refers to as pro-health campaigning (encouraging individual awareness and behavioural modification).

Others include the empowerment model, encouraging personal growth and self esteem and likely to need dialogue, and the radical model with a focus on social, economic, and political

issues and the tactic of agenda setting and lobbying. Associated closely with these models is a growing interest in the style or character of cancer communications in which UGC can play a

role in the future. Downie et al refer to the traditional model or medical model of health promotion by using expert medical recommendations (1996, p34). These are seen as educational

approaches based on a rational choice theory. This value free approach believes that people will make the right choices if they understand the situation. This can be given with Q&A on web sites,

podcasts and vodcasts, using medical experts and cancer sufferers, and can also develop into more immediate communication like chat rooms. Others like Montgomery (1990) and Howe et al

(2002) note the need for the entertainment education models that have educational and entertainment strategies. Such arguments often refer to the success of celebrity or television

soaps in cancer communication models but care needs to be taken with such tactics as recent case studies involving Jordan and a story line from Coronation Street have shown (appendix 4 &

5). Social networking sites like Facebook and Twitter have also created opportunities for the social influence or client community models (Ewles and Simnett, 2003, p44) where the

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4community is strong and collective behaviour works. These can be stimulated by traditional media like BBC Newsline (tweeted@bbcnewsline) or they can be bottom up led like womens forums. An

example is a group of Northern Ireland mums who tweet about their battle with alcohol, and send support messages to each other (tweeted@alcomum). The Ulster Cancer Foundation has

recently taken a step towards a more two way form of communication with the creation of a Facebook page. Through Facebook, key information on up coming events and fundraising events

are easily and cost effectively communicated with key publics.

This potential is also linked to opportunities from blogging in Cancer PR. Abroms et al (2008) research note that the value of blogs depended on monitoring of the site, its promotion and

dedication of the blogger; use of guest bloggers tended to add value. There is a growing number of influential cancer bloggers, attracting cancer sufferers, to give support and advice. Such blogs

also appear to be bringing comfort to the bloggers: an example is the blog of Dr. Anita Roberts who started her blog after being diagnosed with gastric cancer in March 2004 (at http://

www .anitaroberts.net) While research by Yaxley (2007) shows that a sizable number of commercial blogs have little power or are regularly up-dated, and only 10% of the 83.8 million are

regarded as important, some like TechDigest received 2 million visitors a month. It shows the potential value to do good and learn from experts (Broom, 2009, p268). Currently UCF does not

have a blog. For many people, sharing experiences of their cancer journey with others comes in the form of group meetings. However, there may be patients that are unable to attend such

meetings due to location, timing, or the fact they are too unwell. Such publics are therefore missing out on important emotional support. A blog would serve as a go between. Fellow patients,

UCF support staff and medical personnel would be able to communicate on a regular basis which would create an important part of UCFs support services.

3.0 Effective use of Digital PR in Cancer Communications?3.1 New Media and Traditional Media RelationsWhile the main advantages of UGC and digital health PR, is the potential to engage directly with

cancer publics, it can also improve media relations. Research studies have noted the media interest in health, the significant media coverage on health issues, and the value given to media

content by cancer sufferers (PEW Research Centre, 2008; Mac Donald et al, 2001; Carlsson, 2000; Weimann et al, 2006; appendix 6) The fact that 91% of reporters prefer to access

information on-line also shows the need to engage with a Virtual Press Office (Hall, 2005). The Ulster Cancer Foundation has a strong relationship with local media, for many health journalists,

UCF is a first stop for cancer information and comments regarding major announcements or cases. Helping to develop the interactive archive of information via UCFs website will only lead to

a stronger more efficient relationship between the organisation, journalists and members of the public. .

However, with the positives come the danger of negatives (Weimann et al, 2006), p757-8).

Fascinating research points to the media tendency to exaggerate and sensationalise, reduce issues to a basic level and be inconsistent between importance of types of cancer (Wallack et al,

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51993; Kitzinger,1991; Levi, R, 1989; Freimuth, VS, et al; Hoffman-Goetz L. et al 1999: Clarke J. 1986; LEtang, 2008; appendix 7). Other researchers note the media tendency to associate

cancer with the language of war and death, and give an unhealthy interest in children and celebrities with cancer (Clarke,1986; Weimann et al , 2006, appendix 8).

Such conclusions highlight the need for cancer PR professionals to review current media

relations strategy. There is general agreement amongst PR and Health communication authors on what makes for effective media relations, including appropriate writing style, story angles, PR

availability and appreciation of audience - such skills and behaviour are the same for the Virtual Press Office (Theaker, 2008). A typical VPO should include organisational information, service

and product information, Q&As on key topic areas, relevant podcasts and videos, links to other relevant sites, press releases, image libraries and contact details. Generally, it should have

consistent branding and clear design, and be updated regularly (CIPR Guides, 2009). Yaxley (2007) also stresses the need for all members of the team to be trained and take responsibility to

file their information and in 2009 there are issues about the role of PR in digital management (Springstein, 2001, cited in Theaker, 2008; appendix 9/10).

3.3 DIGITAL PR CANCER STRATEGY for UGC: The Principles - Research, Publics, Messages, Channels/Tactics, EvaluationWhether traditional or digital communications, the PR practitioner has to engage with what has

emerged from cancer PR theory; this is crucial to the future success of cancer digital PR strategy and attention to research, publics, messages, channels and evaluation. Digital Cancer PR must

first respond to research findings like the UK study in August 2009 by the National Awareness and Early Diagnosis Initiative (NAEDI) that found that one in seven people cannot name a single

symptom of cancer. Websites and digital tactics must communicate with traditional PR public types but also with specialist cancer publics. For example Miller (2005) refers to cancer patient

types as blunters and monitors and Rimmer (1995) as early adopters, middle adopters and late adopters. Understanding of these types of patients and how they consume digital

information will be crucial to cancer communications success (appendix 11). Engagement with cancer messaging is also important. This should include the extensive research on children and

cancer and how they are influenced and want to be treated and the issue of stress when reading text post diagnosis (Palmgreen and Donohew, 2001, NCI, 2009, Kelder et al, 2000, Miller, 2005);

appendix 12). Very valuable research has been done on the PR language of cancer with support for advice from physicians, the avoidance of vernacular language, the advantage of frequencies

when using numbers, the need for special care when writing for low literacy intended audiences and the importance of language evaluation (Glassman & Rimer, 1999; NCI, 1998; appendix 13).

4.0 UCF, UGC, Present and Future4.1 The Current situationAt present the UCF site follows some of the guidelines for good practice in web and digital PR

activity. Edwards (2009, cited Tench and Yeomans, p151) notes that non government organisations have to communicate effectively with their stakeholders and take their views into

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6account if they want to ensure long term support for their causes. He recommends that this should include evidence going beyond asymmetrical models to symmetrical, two way

communications. This would be to ensure visitors receive as much information as possible about the organisation and its activities, while offering plenty of opportunity for feedback and

content.

Currently the UCF web site has examples of good practice, including: 1. Clear aims and objectives of the organisation

2. An annual report and some evaluation of its activities3. Frequently asked questions and answers, divided into sections according to areas of

most common interest4. Updates and headline articles on the most current activities with which UCF is involved

and progress reports for longer running projects5. A media section with press releases with other communications, reports and reviews

released by UCF6. Educational and school / youth communications / activities

7. Opportunities to contact the organisation by post, e-mail and telephone

There is evidence of good practice within the site from CIPR good practice guides.(Tomlinson, Bailey, Ainley, Leggetter: 2009).

These include:1. A communication rather than technology focussed approach

2. A co-ordinated approach across all PR tactics and media. So the site is integrated with public affairs, event management, fundraising and media tactics

3. Navigation is clear4. It is clearly targeted at its core and local audiences

5. It is written for the screen, not for the page. Text is in small chunks6. Copy is written for skim reading - sub-headings act as signposts - paragraphs make

sense in isolation7. Content is generally up-to-date

8. News adopts the inverted pyramid9. There is use of social media dialogue with a Facebook site

Positive analysis in the context of health public relations theory include: There is clear evidence of publics analysis with sections on cancer types with well

considered questions and answers as recommended by the NCI (1988), and Millers

research on the processing of the cancer patient when stressed or confused (2005). There is also evidence of interpersonal support as recommended by the NCI ( 2009) and

use of early adopters as part of the counselling services (Rimmer, 2005) There is evidence of the need for multi senders in cancer and public campaign

messages as recommended by Leitch and Motion (2003). Senders include experts, teachers, parents and media. There is also appreciation of two step flow theory (Katz

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7and Lazarsfeld (1955) (cited Yeomans, p583). This is the relationship of parent to child, teacher to pupil, husband to wife, wife to husband.

The language used throughout the site is consistent with good practice. There is no association with negatives or war type language (Clarke, 1986; Weimann et al, 2006).

There is no use of vernacular language as recommended by the NCI and the language throughout is suitable to low literacy publics (Glassman and Rimmer, 1999). There is

evidence of appreciation of feelings of late adopters (Rimmer, 1955) and blunters (Miller, 2005); for example in the section called coping with cancer there is

discussion on shock, denial, guilt, fear and resentment and why patients have these feelings.

While the evidence that UCF has engaged with User Generated Communications to current need

and best health communication practice, the time might be right for review and engagement with more symmetrical PR communications.

4.2 PR Models, Cancer Communications and User Generated Communications (PR) a way forward for the UCFThe potential for the Ulster Cancer Foundation in embracing the newer technologies is to achieve

an excellence approach to public relations, combining traditional PR with two way symmetric public relations. Through an interactive web site, chat rooms, blogs, Facebook, broadcasting and

Twitter, the UCF can facilitate the needs of cancer patients, family members and professionals. The new technologies can also embrace an open systems approach by encouraging other

senders like cancer sufferers (especially early adopters) to communicate with those in similar situations. Grunig would refer to such practice (in his excellence model) as understanding,

moving equilibrium, equality, autonomy and interest group liberalism (appendix 13 &14)

The most significant need is to embrace the potential for dialogue. This would need greater prominence of UCFs Facebook site and maybe the use of Twitter. Twitter has been used very

effectively in Northern Ireland for groups in need (tweeted@alcomum). A blog hosted by a member of the dominant coalition within UCF would also be a positive move; this could provide

opportunity to highlight current activity, news and agenda setting within the organisation. Its publics could be broad, from sufferers to media and politicians. Crucial to success would be

adherence to best practice, including daily up-dates and promotion and use of guest bloggers (Abroms et al, 2008).

There is a vital need to introduce broadcasting to the site with potential links to YouTube; such development tend to attract greater traffic, longer stays and added value to any campaign (Abroms et al, 2008). The fact that cancer charity competitors are doing it might give added

incentive (Cancer Research UK, Macmillan Cancer). The opportunity to use cancer survivors and medical specialists on podcast and video could be an attraction to all cancer public types. The

style does not have to take the UCF into the entertainment model of cancer communication but could provide a rational response style found to be suitable to Ulster publics. However, the

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8money raising activities of the Charity including the 4 Peaks Challenge and Summer Santa Runs lend themselves to broadcasting and would add to the possible channels to deliver the core

messages; this has been found to bring added opportunities in cancer communications (McGuire, cited in LEtang, p139).

There is a potential need for additional factual depth within the site. While current copy is suited to the majority, it would be useful to have links to academic and health papers that facilitate the need for monitors depth of study (Miller, 2005). This development could also include a

commitment to keep all parts of the site up-to-date for example the attachment of all annual reports and additional evidence of communication success (evaluation reports and Award wins)

The UCF media strategy has been very successful in coverage and message delivery. If time

allows it might be right to review the current offering with a highlighted section for journalists (a Virtual Press Office); this is especially true given recent research highlighting the emphasis of current news on health, the publics attention to media health issues, and the potential flaws in this coverage like media exaggeration and inaccuracies (McDonald et al, Carlsson, Weimann et al).

The additional detail as suggested for monitors could also be useful for journalists, as could additional broadcasting coverage. With 91% of health of journalists preferring to access

information on-line, investment in a virtual press office is important (Hall, 2005). Critical to this success is the training of all PR team members for such innovation and the use of knowledgeable

PR executives (Yaxley, 2007, Sudhaman, 2009 (PR Week)

5.0 ConclusionThis research aspired to create a theoretical link between digital, new media, public relations and

cancer communications theory. There is real potential for research in this area that could not only bring value to cancer patients but also the reputation of the public relations profession. It appears

that research could also bring case studies of how cancer public relations have taken the industry into the symmetrical model of PR and answer many of the critics of the profession.

As for the Ulster Cancer Foundation, the study shows that the charity practices (what is

considered) excellence in public relations and cancer communications. Ideas have been given for potential innovation and additional development that could take the charity into digital symmetrical

health communications and fully explore the opportunities given by social media and broadcasting. If followed it will take the UCF into Digital PR practice recommended for

communications success in 2010 (European Communication Monitor, 2009, PR Week, October 2nd, p24)

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96. APPENDIX

Appendix 1

In 2008 Jacquie LEtang added a chapter on Health Communication in her book Public Relations: Concepts, Practice and Critique introducing students and PR practitioners to the

extensive and mature theory of health communication (p136-157). Other health communications texts have been important to this study, including Communication in Cancer care (NCI, 2009),

Making Health Communication Programmes Work (NCI, 2009), How the Public Perceives , processes and interprets risk information (NCI, 1998) and Communication: Playing an Integral

Role in Cancer Prevention, Screening and Treatment (NCI,2009). Seth M. Noars 10 review of health campaigns (2006) provides a very good summary of key issues and Abroms et al (2008)

was one of the first research papers on new media and health communication. Digital PR is also a hot PR topic in 2009, focussing on the role of User Generated Communications, web sites, e-

mail, broadcasting, You Tube, blogs, podcasts, texts, and social media like Facebook and Twitter: since January, 2009 every edition of PR Week has had a digital PR story. It dominated the CIPR

Profile magazine (February/ March/ April 2009) and is a regular feature in the national and regional press. The most recent PR books have covered the subject within chapters on media

relations like Broom (2009), LEtang (2008) and Davis (2007 ). Some authors donate excellent chapters to the subject with the acknowledgement that content would be already out-of-date at

publication (Theaker, 2008) and in 2009 the CIPR re-published Online Public Relations as part of the PR in Practice series.

Appendix 2

The OFCOM Communications Market Report (August 6th 2009). While the relevant facts are too extensive for this paper, a selection are

Northern Ireland has seen a significant growth in 2008-9 in Media, Digital Media and social media

Digital TV take up, rose by 10% to 89% of the population

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10

TV viewers in Northern Ireland watch more hours of the nations early evening news bulletins than anyone else in the UK

A third of households in Northern Ireland have watched TV or video on line 11% (and increasing) of adults live in a household that has watched catch up TV 15% of people in Northern Ireland said they had used their mobile to listen to radio, the

highest in the UK 46% of NI people claimed to own an MP3 or iPOD the highest in the UK 64% of households have rapid broadband connection ( a 12% increase annual increase ) 93% of households had a mobile connection the highest penetration in the UK 18% of people in NI claim to use mobile handsets to access the internet Northern Ireland leads the way in the UK for ownership of games consoles ( over 50% of

the population ) One in four households in Northern Ireland use social networking sites ( a 6% increase )

Appendix 3UK Charities have recently begun to use the integrated mix, actively engaging with the new

technologies. British charities Oxfam and Shelter appointed Heads of Digital Communications and in August (2009) Cancer Research UK (CRUK) appointed 1000 Heads to plan a new social

media strategy. This has already included social media to target the younger audience with skin cancer messages, and a T-Shirt design competition on MySpace to raise awareness of breast

cancer (Magee, PR Week, 21st August, p8). Macmillan Cancer support are also turning to user generated communications to raise money, build partnerships and create interest from younger

audiences. In July they launched a new website, the Worlds Biggest Coffee Morning that raised 7.6 million last year. Registration for the initiative entered the participant in a draw with

prizes donated by Somerfield; entrance also allowed stories to be told for potential traditional media use. Macmillan have also taken video and cancer stories into the risk area of humour;

instead of traditional talking heads The Sex Guru was launched as an on-line clip and achieved 400,000 hits (Magee, PR Week, 17th July, p10) ( www.macmillan.org.uk/sexguru.).

Appendix 4

LEtang cites Howe et al s , (2002) research that gives the example of a character from Coronation street who died from cervical cancer the result was that in the North West of

England, NHS screening increased by 21.3% in the 19 weeks that followed the story line

Appendix 5Jordans association with breast cancer campaigning has, however, shown the dangers of using

what Rojek (2001, p17) has called attributed celebrities rather than achieved celebrity gained from professional knowledge and expertise. The association of spin in this cancer PR / digital pr

environment has also recently brought negative publicity. In early September the producers of Coronation Street announced that character Sally would be diagnosed with breast cancer. The

chat rooms initially welcomed the story but when on the 30th September a press release declared that husband of Sally, actor Kevin Webster, may leave the show depending on the

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11

outcome of an upcoming storyline. if his character doesn't stand by wife Sally when she is diagnosed with breast cancer the on-line conversations saw through the threat and declared it a

publicity stunt (BT, TV, 30th September, 2009)

Appendix 6There has been some fascinating research on health issues and cancer stories in the news. In

2008 the PEW Research Centre published an excellence report on How the Media cover Health. The 18 month study, across all American media types concluded that health news was

the 8th biggest subject in national news / 3.6% of all coverage. Network evening news was the most likely to find health news with 8.3% of air time given to health (mainly on cancer and heart

issues, cable news was much less cancer news still dominated). Cancer got 10.1% of all coverage. For the general public the mass media was the most important source for health issues

(Mac Donald et al, 2001). Those not getting satisfactory health information from health staff and doctors turn to other sources. Carlsson (2000) cancer study concluded that 86% found

information from newspapers, 82% from television and radio and 6% from the internet. Weimann et al (2006) cite an American national poll in 1997 that concluded that 75% of the population pay

attention to health and medical news.

Appendix 7Wallack et al (1993) argue that the media is over used in health messaging, noting that the

messages are reduced to the basic level in issues that are complex (for example, say NO campaigns). Some stress the uneasy alliance between the source of science, like researchers

and medical practitioners, and the media. Scientists can perceive journalists as unscientific hacks who are merely there to exaggerate or give emphasis to stories that will sell papers rather

than give valuable messages. In some cases this means creating panic and cases verging on the Armageddon the recent cases of avian and swine flu are given as examples (LEtang,

2008).Some have drawn attention to mass media fantasy where messages are sometimes discussed in the environment OR context, where tobacco, alcohol and drugs are glamorised.

Studies point to mistakes, distortions, inconsistency between importance of topics and the

reluctance to cover issues regarded as important to the medical professions (Kitzinger,1991) Inaccuracies, lack of knowledge of scientific process and editing for sensationalism is also

criticised (Levi, R, 1989). Numerous cancer studies support these findings (Freimuth,VS, et al), with special criticism for cancer reporting in womens magazines (Hoffman-Goetz L. et al 1999:

Clarke J. 1986). These studies showed that difference of emphasis in coverage does not reflect reality for example, the significant coverage of breast cancer (also cervical, ovarian, skin),

rather than lung cancer, that kills more women. There was criticism of the quality of the information and inadequate quoting from official bodies this, it was noted, could impact on

perception of risk and preventative behaviour.

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The researchers noted other important discrepancies; ovarian cancer, which in reality is highly lethal (around 75% mortality) was not represented as such in the media (only 28.6% of the

articles dealing with this type of cancer mention death, a disparity of 47%), while the media associate melanoma with death much more frequently than is reality (p760). Some studies have

questioned the professional qualifications of health reporters and criticise their failures to verify data before publication or broadcast (Brezis, 2002).

Weimann et al (2006) conclusions from their research were: The media focus on interesting stories that will get coverage and sell papers dramatic

accounts, heroic struggles or moving tragedies The popularity of childrens cancer stories these stories are more dramatic, shocking

and enthralling It is also noted that the medical professions use this with the promotion of hospital visits like sports stars

Quality of coverage depends on the professionalism and specialism of the reporters and the media outlets readership

That key actors are important in the success although not mentioned by the authors the conclusion is that the spokesperson, medical specialist gets maximum coverage

when managed by someone who knows how the media works. The majority of coverage is human stories often well known personalities this gives a

distorted focus to certain types of sickness.(p761)

Appendix 8Clarkes (1986) research highlights the military language used in cancer coverage like fighting

cancer, cancer the killer, cancer the murderous disease, the victims of cancer, conquering cancer, radiological time bomb and early warning systems. Good or bad, language is an issue for further

research. Of concern is the association of cancer and death. Weimann et al, 2006 suggest that the media emphasise the topic of death in connection with cancer more than its actual frequency,

due to the medias preference for coverage of negative subjects and its inclination to dramatize (p760)

Appendix 9

Management issues with virtual press sites need to be addressed. Weimann et al (2006) notes that reporters often rely on public relations people as sources of information about health issues;

a practice that can lead to distortion in reporting due to the involvement of outside interests. This criticism on health PRs suggests that charities are businesses, often in competition in the cancer

sector; it further suggests that news releases might give biased opinion. A second point is that only 16% of sites are programmed by PR specialists (Springstein, 2001, cited in Theaker, 2008).

This is a clear challenge for a professional aspiring to have a boundary spanning control within the organisational dominant coalition. Thirdly the virtual press office brings value to setting

agendas and partnering the media in pressurising government decision making currently this means web-sites being clear on organisational policy on the likes of drug availability (OReilly, PR

Week, Sept 4th, p20-23; PR Week, September, 2009;)

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Appendix 10September 2009 has also brought analysis cancer drugs public relations to the fore (OReilly, PR

Week, Sept 4th, p20-23) Using traditional, political elites like media activists, cancer sufferer groups and drug companies have brought social issues to the news media attention, making it

news, testing public opinion on an idea and creating social pressure. In an era of digital communications and demand for 24 hour supply of news it is crucial for cancer organisations to

be clear on their policy relating to specific drugs and have rational fact available for news consumption. The media interest in the drugs debate has been fueled by the opportunity for a

news angle and the sensationalism it attracts the target for their anger the National Institute for Health and Clinical Excellence (NICE) who appraise drugs and their suitability for use. In turn,

National Health Trusts follow this advice when deciding whether or not to use the drug. The failure to agree to the use of the drug Herceptin, for women in the early stages of breast cancer,

and the kidney cancer drug Sutent on grounds of cost, have caused a media storm and led NICE to turn to digital communications. While not getting involved in dialogue they have put all

decisions on drugs and reasoning on their decision making, on their web-site. (PR Week, September, 2009)

Appendix 11

Monitors are attuned to informationthey will oftenamplify or exaggerate itthey will surf the web and read everything they can get their hands ontheyre happy to discuss details of their

illness, and take in all the comfort and reassurance offered. Blunters, in contrast, distract from information they tune it out and de-emphasise it.they dont want to dwell on their illness, and

would rather be distracted and let life go on. What is significant for the PR professional is to reflect on the potential impact of this in the commercial world communication with a public might

mean minor difference in percentage of sales, or numbers at an event in health communication it can be a matter of life or death. Miller gives this example of blunters and monitors who have

breast cancer: breast cancer often involves a lot of conflicting medical advice and decision making on the part of the patient. We know that for early- stage breast cancer, lumpectomy with

radiation is an effective as mastectomy. But some women especially monitors end up opting for a mastectomy even when its not medically necessary, because they cant deal with the

anxiety of possible recurrence if they dont have the entire breast removed. These decisions then become very anxiety-driven, rather than driven by rational, evidence based, medical

considerations.

Rimmer (1995) research study of audience and messages for breast cancer and cervical cancer screenings used public descriptions as early adopters, middle adopters and late adopters.

Early adaptors describe publics that are won over by the cancer education or communications and can be used to encourage other women to take up potential treatments. Such segmentation

can therefore have significant impact on PR tactics.

Appendix 12

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14

Message design and targeting is vital in health communication success and there is a wealth of research data on the subject. Research on youth health communication note the importance of

drama, intensity, novelty, emotion, a lack of preaching, and fast pace (Palmgreen and Donohew, 2001, cited p30). Other studies have highlighted humour, short term consequences and positive

role models (from Kelder et al, 2000, cited p 30). Studies show that children with cancer want to know about their illness and how it will be treated. The amount of information a child wants

depends, in part, on his or her age. Most children worry about how their illness and treatment will affect their daily lives and the people around them. Studies also show that children have less

doubt and fear when they are given information about their illness, even if it is bad news (NCI: 2009).

Miller (2005) notes that research shows that cancer patients have difficulty processing

information even when theyre not stressed what is read to them or said to them and what they read and hear particularly when it involves numbers, probabilities, unfamiliar terms and

procedures, can lead to confusionthey edit information.so it is important that the initial visits be of very high quality. She concludes the challenge for PR and UGC in health communications

is to continue to find ways to bridge that gap between all the information available to us and provide it to individuals in ways that serve their practical needs

Appendix 13

Interesting to messaging, is research about the communication of cancer risks and use of language (NCI, 1998, How the Public Perceives, processes and interprets risk information: Findings from Focus Group Research). The study found that facts relevant of appreciation with digital media:

Publics trust messages from physicians rather than business or journalists.

Statistical information was difficult to understand percentages were more

understandable than ratios

Brief texts and visuals can increase attention

Word choice is important

Key questions need to asked and answered with where to go to get additional information

When faced with bad news about cancer risks they looked for reasons why it did not apply to them.

Key was that risk messages should have hope of prevention and written optimistically.

Additional research has been done on the language of PR activity relevant to cancer. NCI

research found vernacular language used to discuss diarrhoea on a booklet on chemotherapy for low literacy publics was not liked. Readers found it offensive and preferred

technical discussion, even though it had a higher reading level. Another research analysis of re-call in lung cancer patients found they could only remember an average of 2 of 12 ideas

presented. Reasons included use of technical terms and details considered unimportant to

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readers. The 2010 REPORT and NCI list attributes of effective health messaging common to much of the standard PR literature. They are Accuracy, Availability, Balance, Consistency,

cultural competence, evidence base, reach, reliability, repetition, timeliness and understandability, Research on direct mail for cancer publics focus on stimulus to act, and

good practice in developing print material for low literacy intended audiences. Glassman & Rimer (1999) study found that birthday cards and letters/newsletters had significant impact on

target audiences quitting smoking, attending for Pap tests and general cancer screening. Research outcomes from Healthy People, 2010 note that copy and design should:

include only information needed to convey the behavioural objectives organise topics in the order the reader will use them present the most important points first and last group information into chunks, with clear ordered format respect the audience

British research has also highlighted the importance of language used (Knapp, P et al 2009, pp579-594). The study concluded that unclear medicine literature led patients to overestimate the

risk of side effects by up to 50% and can influence their decision about whether to take prescribed medication. The research noted the dangers of using percentages in leaflets rather

than natural frequencies like one in five. Generalised terms like common, very common and uncommon were also criticised for lack of clarity.

The debate on the need for more sophisticated evaluation methods other than AVE and OTS is

well appreciated in health communications. This began well before Noars study (Pirie, 1999;p127-134; Rice & Atkin, 2001,p146-167). Noar suggests that the lack of gold standard

evaluation could be due to 1. The funds were not adequate to increase the rigor of the designs, or 2.the researchers were not aware of the significant weaknesses with this design or were aware

but simply viewed it as an acceptable research design (p31). However despite limitations the relationship of aims and objectives to evaluation is well appreciated in cancer communication

literature (e.g University of Kansas community toolbox - http;//ctb.lsi. ukans.edu/tool/CVS/socialmarketing/outline.htm.). It is clear that cancer PR practitioners are well positioned to adopt

the more sophisticated approaches to digital PR evaluation.

Appendix 14Perhaps the best argument for moving the UCF to give greater emphasis to UGC is the

complexity of the cancer communication environment that is represented in the newer models of public relations (Dozier et al,1995); Flynn, 2006). User Generated Communications has a major

role to play within the pure co-operation model in convincing the dominant coalition (as in national and local government) to listen and respond to the Ulster Cancer Foundations

campaigns, as it will with the TWO WAY MODEL were communication is used to move the

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dominant coalition, or public, or both, to the win-win zone this is the complex zone in which well managed web and social media sites can respond to complex systems and the issues that

emerge from them this can be related to government financial announcement, debate on a cancer drug like Herceptin, the portrayal of a cancer sufferer on a soap, or discussion by cancer

sufferers and professional on medication and diet. This complexity is well presented in Flynns (2006) multidimensional model where dialogue, collaboration, and negotiation with multiple

stakeholders and stakeseekers occur simultaneously and that the new role of the public relations practitioner is to maintain an equilibrium that satisfies the mutual interest of all parties (p193).

The technologies might also allow the concerns like power imbalance and bias of the critical

school to be answered. For many years the critical school, including LEtang, Moloney and Pieczka have argued that there was an imbalance in the power relationship between the sender

and receiver in communication, made worse by the skills of the PR practitioner and the declining power and time of the media. The adoption of new media will allow for the UCF to construct and

send quality information to publics, service the media through efficiency in their virtual web-site and encourage the dialogue that reduces the chances of imbalance in power. With effective and

ethical management and application of UGC, the UCF can become an example of the difference between what John Stauber, co-author of Toxic Sludge is Good for You calls, public relations and

the public relations industry, between big PR and little pr; He notes democracy is very dependent on people learning the art of rhetoric, learning the art of communications and being

able to communicate their ideas and persuade others. (cited in Moloney, 2006, p78) Moloney also cites Miller who he states it is difficult to see the promotional dynamic in wholly negative

terms when it provides some of the very few opportunities for the powerless to answer back (p78).

Appendix 15

Flynns Balance Zone model represents the realism of multiple stakeholders and publics, using everything from advocacy to mediation, to work within an open system. From this system that

includes organisational, group and media communication and is in constant motion comes the outcomes. While the publics and factors that apply pressure on the organisation are he notes

situationally specific (p196) he believes there are nine common factors that will help organisations have a more stable and predictable balance zone. The degree the organisation

fosters and supports mutually beneficial relationships with its key stakeholders (Relational mindset) and the reputation the organisation has with those groups. Also the civic and social

responsibility shown by the organisation with appropriate ethical dialogue and decision making. It is also significant if the organisation has to adhere or is monitored by government (regulatory

regime). In addition economic and market pressures, real and perceived risk and media visibility are important. Finally the threat of internal and external activism play a role (p196).

7.0 BIBLIOGRAPHY :

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